Provider Demographics
NPI:1831684067
Name:STOCKER, SALLY (LCSW)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:STOCKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PMB 705
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84326-7719
Mailing Address - Country:US
Mailing Address - Phone:435-232-3069
Mailing Address - Fax:
Practice Address - Street 1:240 W 200 S
Practice Address - Street 2:PMB 705
Practice Address - City:MILLVILLE
Practice Address - State:UT
Practice Address - Zip Code:84326
Practice Address - Country:US
Practice Address - Phone:435-232-3069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-29
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
UT11765645-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor